TH E JO U R N A LO F BO N E & JO I N T SU R G E R Y · J B J S.O R G VO L U M E 87-A · NU M B E R 10 · OC T O B E R 2005
XI M E L A G A T R A N CO M P A R E DW I T H WA R F A R I NF O R PR E V E N T I O N O F TH R O M B O E M B O L I S M AF T E R TO T A L KN E E AR T H R O P L A S T Y
Electronic Appendix The EXULT B Study Group
The members of the EXULT B Study Group are as follows: Ex- ecutive Committee: Charles W. Francis (cochair), University of Rochester Medical Center, Rochester, New York; Clifford W.
Colwell Jr. (cochair), Scripps Clinic, La Jolla, California; Philip C. Comp, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Jeffrey S. Ginsberg, McMaster Uni- versity, Hamilton, Ontario, Canada; Jay R. Lieberman, UCLA Medical Center, Los Angeles, California; Guy Paiement, San Francisco General Hospital, San Francisco, California; Scott D.
Berkowitz, AstraZeneca LP, Wilmington, Delaware; Jennifer McElhattan, AstraZeneca LP, Wilmington, Delaware; Anne W.
Roth, AstraZeneca LP, Wilmington, Delaware; and Seva Pan- filov, AstraZeneca R&D, Mölndal, Sweden. Data Safety Moni- toring Board: Robin S. Roberts (chair), Hamilton Civic Hospitals Research Center, Hamilton, Ontario, Canada; Mar- vin Steinberg, Hospital of the University of Pennsylvania, Phila- delphia, Pennsylvania; and Alexander G.G. Turpie, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada. In- dependent Central Adjudication Committee: Michael Gent (chair), Jack Hirsh, Clive Kearon, Mark Levine, and Jeffrey Weitz, McMaster University, Hamilton, Ontario, Canada.
Site Investigators and Coordinators
The following institutions and persons participated in the study (principal investigators are indicated by an asterisk, and the pre- vious principal investigator for the clinical site is denoted by a dagger symbol): United States: Arizona — J.A. Dupont,* R.
Korn; Arkansas — W.F. Hefley, Jr.,* W.S. Bowen, K.A. Martin, M. Alexander, S. Marti, K. Mills, K. Mercer, P. Short, L. Hast- ings, R. Satre, K. Weaver, D. Jacks; California — G.W. Bradley,*
S.A. Plunkett, S.M. Ford, S. Braverman, J. Wrench, L. Harter, D.
Fox; C.W. Colwell, Jr.,* S.N. Copp, M. Saeed, K. Ezzet; S.T. Gh- erini,* S. Croopnick, D. Wentworth, B. Fellmeth, C. DeLemos;
H. Kim,* H. Jergeson, R. Sawhney, S. Wall, K. Stanley, A. Sabal- vara-Torres; R. Mudiyam,* D. Tapadiya, G.S. Patel, M. Soroudi;
L. Kwong,* S. Slaugher-Markman, P. Ballesteros, B. Morrow, S.A. Mikulak, J. Harvey, D. Feingold, M. Hewitt, R. Larson, J.
Ballesteros, B. Wiley; C. Libanati,* P. Reiswig, G. Watkins, A.
Gustafson, D. Wallace, K. Anderson, S. Closson, K. Jolley, N.
Hamada, O. Hohmann, T.K. Donaldson, A. Firek, D. Barnes, M.
Patel; W. Navigato,* M.T. Mai, R.P. Sakover, D.D. Kim, N.J. Hal- bridge, J.B. Gonzalez, S.P. Suzuki; T. Miclau,* G.D. Paiement,†
A. Davidson, E. Ring, H. Kim; D.R. Shah,* J. Stockwell, J.C.
Kim, M. Shah,* K.M. Cirimelli; G. Vallier,* C. Caporiccio, L.
Tocchi, M.C. Garcia, R. Burky, Jr., K. Shimansky, M. Schneider, D. Smith; R. White,* D. Link, B. Bowman, J. Rodrigo, J. Mee- han, M. Wilde, J. Robbins; M.P. Kimball,* A. Sauer, H.J. Ander- son, R.A. Sauer; L. Walker,* W. Navigato, M. Soroudi, J.H.
Block; Colorado — P.N. Lammens,* K. Carlton, D. Hunter, J.
Guyon; J.D. Papilion,* R.L. Greenberg, J.P. Lindberg, H.A.
Motz, F.K. Yamamoto, T. Nash, R. Allen, J. Ferrari, D. Chang;
Connecticut — C. Lewis,* S.F. Schutzer, J.C. Grady-Benson, G.A. Zimmerman, W.J. Glucksman, M. Pederson; Florida — D.G. Bramlet,* L.M. Gnage, R.G. Hamilton, B.R. Bolhofner,
R.L. Swiggett, Jr., C.B. Davis II, M.J. Smith, J.A. Rodriguez Jr., W.E. Lowry, B.D. Burke, G.H. Canizares, R.P. Nantais, B.D.
Fishalow, C.A. Finn, D.A. Rubins, J.D. Stone, G.A. Call, J.M. Va- lone, V.C. Page, B.J. Klug, N.M. Farone, T. McTigue, N.P.
Lausch, F.T. Wilkins, A.A. Sharf, K.R. Kirn, C.M.C. Ruiz; O.F.
Cannon, Jr.,* R.J. Brill, T.D. Lowell, T.E. Lafferty, J.E. Fletcher, K.L. Hisey, J.H. Huddleston, R.E. Prieto, J.R. Locker, N. Burch, A.E. Mattheus, V.B. King, M.C. Standley, S.A. Vining, M.P.
French; K. Duane, L.P. Bitting, H.J. Smith, III, M.S. Farber; S.I.
Hakki,* S. Harwood, J. Hoeldtke, V. Bilotta, S. Coleman, J. Jen- kins; S. Augustine,* L. Derting, J. McAdams, B. Yearty, J. Ollie, D. Darracott, P. Baumann, D. Siragusa, H.M. Northrup, J. Vu;
G.S. Kantor,* K. Vaughn, N. Joyce, R. Sarner, W.P. Roemer; M.J.
Koren,* S. Neims Greco, J.A. Jacqmein, R.O. Pohl, Jr., D.M.
Helmsworth, F.W. Sanchez, D.M. Robison, S.J. Lancaster, D.A.
Whitaker, F.A. Hakim; L. Mead,* S.S. Brady, B.L. Woodard, C.E.
Stahl, K. Lee-Sinkler, J. Polen, G. Rego, S. Lagman; H.B. Mor- ris,* K.A. Krumins, J.B. Billings, J.F. Byrnes, Jr., R.C. Prati; H.
Schuele,* W.A. Hughes, J. Kilgore, C. Abrahamsen, M. Ben- jamin, F. Persechino; R. Strain, Jr.,* A.J. Reich, W. Grossman, S.D. Steinlauf, M. Kravitz, J. Blaze; W.K. Furman,* D.M Karp, W.R. Kennedy III, E.J.G. Kennedy, D.A. Sugar, D.J. Slevin, R.J.
Lichtenstein, F.M. Tow, F.T. Wilkins, A.A. Sharf, C.M.C. Ruiz, N.P. Lausch, T. Finan, V.C. Page, B.J. Klug, H.W. Vogler, C.A.
Diaz, C.W. Rush, G.S. Sharpiro, K.R. Kirn, N.M. Farone, J.R.
Ayers, R.A. Smith, Sr.; Idaho — C.E. Poole,* D. McGee, N.C.
Femino, J.A. Thomason, B. Nelson; Illinois — G. Allan,* D.J.
Olysav, T. Renfree, L. Klingler, W. Payne, C.M. Bearss, W.
Moore; Iowa — J. Kimelman,* M. Flapan, M. Matthes, R.E.
Johnson, M.S. Rosenfeld, T. Kenney, S. Meyer, S. Misol, W.C.
Young, L. Kiley; Kentucky — F.A. Burke,* H. Lockstadt, J.K. Far- ris, G.L. D’Angelo, N. Ellingsen, V.A. Vaslcek, J. Balthrop, T.D.
Cervoni, K. Schlenther, D. Winebrenner, E.S. Wilhite, E. Harris, P.M. Brown, C. Riley; A.A. Yashar,* A. Tapp, E.E. Jacob, P. Lin- ville, J. Sunderland, T. Ramey; B.A. Wittmer,* J.M. Donley, J.E.
Mesa, S.L. Davis, G.M. Garrett, J. Young, T. Furgerson, J. Esser, B. Holder, C.M. Pinkerton; Louisiana — E.J. Lisecki,* D.A. Ber- nard, H.J. Hebert, Jr., J.O. Landry, B. Snellgrove, T.T. Landry, P.
Davis; Maryland — D.F. Dalury,* K. Groh, M.J. Adams, L.F.
Kiniry, D. Faison; K. Larson,* R.K. Chung, J.J. McLaughlin;
Montana — D.L. Woolley,* P.B. Peterson, M. Stewart; New Jer- sey — A. Pagliaro,* T.J. Capotosta, Jr., D.J. Fletcher, K.
McGuigan, K. Banglawala, R. Agri, C. Terry, K.L. Kunkle, M.J.
Levine, G. Tusay, A. Meyers, J.R. Schnell, W. Gomez, R.J. Col- lins, P.J. O’Donnell, P. Holtzman, M.S. Bursack; New York — C.W. Francis,* S.A. Bean, A.D. Boyd, Jr., K.L. Kaplan, E. Spreng, J.M. Shults, D.L. Waldman; H.F. Riegler,* J.D. Marquardt, M.P.
Neracker, D.B. Wopperer, J.A. Schuster; I. Ziv,* J. Haumesser, C.
Meinking, J. Mikulsky, K. Ammerman, E. Sattelberg, M. Cook;
North Carolina — T. McCoy,* J.B. Mason, R.B. McBride, Jr., T.H. Buter, W.G. Moorefield, Jr., W.L. Griffin, M. Ohl, A.L.
Rhyne, III, P.P. Gilbert, T. Fehring, B.V. Darden, II, M.H. Long, A. Smidowicz, J. High, H.Y. Dunaway, III, J.S. Gaul, III, J. Jester, D. DuPuy, A. Guirgues, P. Capecci, R. Fields, B. Arnold, D.S.
Uri, D. Ballard-Wright, N. Summers, K. Prassas, J. Beaghan, J.E.
Foster, S.R. Cooklish, K.R. Crump, T.D. Thomas, D.M. Banit,
TH E JO U R N A LO F BO N E & JO I N T SU R G E R Y · J B J S.O R G VO L U M E 87-A · NU M B E R 10 · OC T O B E R 2005
XI M E L A G A T R A N CO M P A R E DW I T H WA R F A R I NF O R PR E V E N T I O N O F TH R O M B O E M B O L I S M AF T E R TO T A L KN E E AR T H R O P L A S T Y
M.A. Dobzyniak, M. Talbert; Ohio — J. Rusin,* A.S. Kaufman, B. Martin, B. Connolly; R.L. Kalb,* G.P. Rothhaas, B.A. Martin, M.A. Ramsey, M.S. Wheeler, A.S. Kaufman, T.L. Wheeler, M.M.
Razook, S.A. Williams, D.A. Coreasel, K.A. McConnaughy;
W.B. Stanfield,* M.S. Mooney, E. Martinez, L. Allegretto; Okla- homa — Phillip C. Comp,* S.W. Farriester, C.W. Beam, D. Al- exander, F.E. Rabe, K.R. Robinson; Oregon — K.C. Buehler,*
D.A. Rogers, S.R. Tyler, R.L. Thomas, T. Clautice-Engle, D. Sils- bee, C. Nix; Pennsylvania — B.E. Gunnlaugson,* J.M. Moses, I.
Katz, D.A. Lowry, V.E. Vena, R.D. Schroeder, P.J. Ridella, K.
Betcher, D.H. LeHew, M. Buday, O. Cooley, S. Kaselar, J. Burda, P. Wolfe, P. Lorditch; P.A. Lotke,* J.P. Garino, C. Nelson, W.
Ritchie; South Carolina — R.J. Friedman,* M. DeVito, D.J.
Skinner; Texas — Roger H. Emerson, Jr.,* J.M. Hillyard, R.D.
Reitman, L. Higgins, M. Jenson, N. Alexander, T. Wen; G.S.
Gill,* C. Dihenia, A. Romero, T. Hegstrom, J. Stark; P.C. Peters, Jr.,* G.E. Maale, M.J. Champine, M.M. Katz, W. Dittman, L.
Smith; J. Seaquist,* C. Bales, T. Fletcher, C. Craig, M.V. Hill, K.M. Cusick; S.J. Siff,* M. Skolkin, J. Wade, G. Landon; D.L.
Fox,* R.E. Wilcox, P.L. Kujawa, K.W. Rohweder, B.E. Schulze, S.L. Sledge, M. Froman, A. Book, S. Sykes; Virginia — M.W.
Wolfe,* S.C. Mull,† P.P. Jones, P.L. Standifer, R.F. O’Brien, B.A.
Bradshaw, A.J. Manville, D.J. Novak, B.A. Torre, B. Spetzler, A.N. Hicks, M.S. Smith, A.A. Durham, L. Richey, J.A. Porter, C.L. Guth, S. Harrell, W.C. Atkinson; Washington — W.L. Lan- zer,* T. Allen, S.R. Parlkh, G.S. Ferguson, K.J. Randall; Canada:
Alberta — M.J. Mant,* L.M. Larratt, D.B. Russell, A.R. Turner, D. Au, J.G. Cinats, D.W.C. Johnston, P.A. Donahue, P. Kochan- ski, L. Haykowsky, G.H. Woolsey, M.A. Hamilton, M.V. Lavoie;
L.K. Bredo,* R. Perlau, W.R. Reikie, T. Pearce, D. Danciulescu, S.
Danciulescu, A. Poole, B. Capusten, Y. Bos, L. Humbke, C. Cun- dal, J. Glen; British Columbia — L. Vickars,* P. Galbraith, S.
Horlick, D. Werry, J. Barberie, C. Li, G. McKenzie, W. Yu, H.
Hawk, K. Stothers, P. Harrison, P. Chipperfield; W. Pisesky,*
D. Boyce, G. O’Connor, T. O’Farrell, J. Oliver, G. Kindrachuk, S. Krywulak; P. McAllister,* C. Landells, M. Stanger, D. Lawer- ence, S. Southerland; C. Cameron,* W. Malone, B. Woodruff, P. Gutmanis, F. Kernachan, J. Bonnell, P. Trepamier; Manitoba
— V. deKorompay,* J.E. Irving, S. Ulrich, D. Balageorge, G.W.
Pierce, S. Stewart; New Brunswick — S. Dolan,* B. Archer, S.
Connolly, K. Crane, T. Cambell; Ontario — P. Wells,* Melissa Forgie, R. LaRose, P. Murnaghan, J. Aquino, M. Rodger*, J.
Brunet, G. Dervin, P. Kim, K. Cernohorsky, R. Feibel, A. Gi- achino, P. Thurston, P. Rasuli, S. Cartier, H. Hrushowry, W.
Castle, K. Nemeth, C. Carruthers, A. Alton, V. Agarwala; D.
Puskas,* T. Wilson, T. Boudreau, J. Jones, P. Clark, C. Culli- nan, R. VonRichel, S. Stoger; F. Abuzgaya,* H. BenFayed, S.
Gallay, M. Hahn, J. Hummel, E. Sue-A-Quan, B. Woolford, E.
Urovitz, P. Thompson, J. Lichtfuss, R. Kaminker, M. Prieditis, R. Luba, M. Zwicker, R. Firsoff; S.W. Bartol,* D. Danciulescu, S. Danciulescu, D. Fleming, G. Koppert, R. Yovanovich, G.
Annisette, J. Pepin, P. Reynolds, G. Jasey, N. Romanello, W.
Ramsewak, P. Tadros; M. Bent,* R.M. Brock, E.J. Rumble, M.
West, E.C. Orsini, D. Dejewski, H. Dief; G.A. Crawford*, J.P.
Delaney, A. Casses, R. Velazquez, B. Pressnail, S. Styling, W.L.
Robinson, P. Voorheis; L. Flores,* C.M. Offierski, J. Ostrowski,
D. Zaniol, D.L. Mallette, T. Li, R. Dan, H.C. Li, D.B. Lee; R.G.
Josefcheck,* P.F. Robert, D.C. Martin, J.M. Aubin, M. Orshin- sky, D. Nazar, G.C.F. Cook, M.J. Kalchman, R. Rawson; M.
Kliman,* M. Roscoe, G. Vincent, M. Wood, A.E. Maraghy, M.
Mehta, J. Sinclair, M.E. Rick Zarnett,* T.K. Chan, J.J. Wilson, J.
Weiss, B. Smith-Mateschitz, G. Paul Taruli, D. Danciulescu, Shefania Danciulescu; C. Watson*, G. Soon-Shiong, N. Wolf- son, K.J. Mac Con, D. Nemtean, D.H. Pham; V.B. Sennik*, D.
Simmonds, J. Stewart, R. Saplys, N. Clements, D. Wilson, H.
Cheah, D. Davidson, H. Hink, A. Ahmed, T. Stokes; M.
Crowther,* J. Douketis, J. Dobranowski; J. Allen,* J.R. Turn- bull, S.J. Kearney, M. Yee; P. Ansari,* J.Y. Song, B. Rittenhouse, R.M. Aggarwal, S. Demers, E. Nesbitt, S.R. Orsini; A. Chris,*
T. Hupel, J. Israel, P. Schuringa, D. Stevens, P. Stevenson, K.
Tilma, C. McCoy, N. Shenouda; M.J. Kovacs,* S. MacDonald, R. McCalden, C.H. Rorabeck, R.B. Bourne, P. Kudo, M. Rob- bins, C. Talbot, R. Harris, D. Peck; E. Dessouki,* A. Ali, A.
Clark, A.S. Ibrahim, M.G. Martin, C. Osinga, A. Myers, C.
McCallum, H. Lang, L.M. Ames; J. Cisa,* E.J. Robinson, S. Tu- bin, D. Healey, R. Greco, C. Cunningham, L. Forestell, D.
Kelly, N. Beaudry, R. Desjardins; G. Jaroszynski,* M. Suther- land, J. Thomson; Prince Edward Island — A.W. Profitt,* B.E.
Ling, B. Grant, J. Goodwin; Quebec — C. Demers,* C. Petit- clerc, G. Cantin, P.F. Leblond, J. Lyonnais, R. Delage, C. Doyle, J.-M. Turcotte; L. Desjardins,* A. Milot, P. Langis; Israel — D.
Robinson,* R. Avisar, A. Elbaz, A. Oron, A. Peer, A. Altschuler;
M. Roffman,* A. Eyal, M. Aharon, M. Zaidman; Mexico — F.A. Rico,* J.G. Díaz, B.R. Marín, P.J. Elguero, C.A. Rubio;
G.E.M. Reyes,* R.E. García, V.R.F. Castellanos, L.E.M.
Pedroza, J.L.C. Arellano; J.M.M. Camacho,* J.M.J. Avila, S.B.P. Gonzalez, I.L.V. García, J.R. Avila, A.M. Pimentel, V.M.M. Ruelas; J.J.P. Correa,* F.J.M.M. Delgado, I.R. Galvan, J.A.P. Paniagua, I.G. Mendoza, H.Y. Simon, M.C. Villasana;
E.G. Sanchez,* L.N. Rodriguez, E.R. Contreras, F.H. Shoji, R.C. Jimenez, A.C.O. Vallin, D.E.O. Martinez, J.M.H. Campos, J.G. Perez, S.B.P. Gonzalez; S.R. Boschert,* R.C.B. Valladares, J.M. Vargas, J.I.B. Acata; A.D. Fernández,* G.D.R. Argomedo, R.Q. Moreno, L.O.L. Montoya; Brazil — A. Hernandez,* G.T.
Sguizzatto, R. Fecuri, Jr,. I. Momiy, H.K. Iri, C.A. de Souza;
J.B. de Miranda,* I.H. Barcellos, W.E. de Brito, N.S. Yamada, G.A. Alves, L.M. Ceravollo; M. Moreira,* T.Y. Neto, M.L. Si- monetto, A. Moreira, R.P. Buainaim, M.A. de Oliveira Sales, H.K. Farahat, C. de Farias Almeida Alves; M.A.P. de Andrade,*
J.P.K. Matushita, W. Lemos, D.P.B. de Sousa, R.B. de Carvalho de Costa, L.H. Vilela, B.P.C. Fontes, R.L.C. de Resende; N.
Severino,* O.P.A. de Camargo, R. Fecuri, Jr., L.S. Razaboni, N.
Toledo; C.R. Schwartsman,* I. Schmiedt, G.K. de Oliveira, G.L.S. de Freitas, D.P. Tarasconi, A. da Silva Padilha, A.C.
Maciel, A.M.F. Garcia, A. da Silva Padil ha; J.F.A. Pozzi,*
P.C.G. Prestes, S.C. da Costa, L. Zamprogna; S. Mainine,*
P.C.Z. de Faria, R.G. Mombach, A.M.C. Valadao de Freitas, F.V. Carvalho, F.C. Barcelos, E.K. Murata, C.J. Shimizu, C.
Fumo, C.V.F. Kudo, R. do Nascimento Barbosa; G. de Andrade Souza,* M.A. Ribeiro, A. Neser, F. Nasser, S.K. Gertner, M.H. Matsumoto, J.C.S. Simabukuro; C. Milani,* E.K. Mu- rata, S.D. Squassoni.
TABLE E-I Surgical Details of the Efficacy Population
Characteristic Ximelagatran (N = 982) Warfarin (N = 967) Type of surgery*
Unilateral total knee arthroplasty 940 (95.7) 921 (95.2) Bilateral total knee arthroplasty 42 (4.3) 46 (4.8) Reason for total knee arthroplasty*
Osteoarthritis 925 (94.2) 923 (95.4)
Rheumatoid arthritis 46 (4.7) 35 (3.6)
Other 11 (1.1) 9 (0.9)
Type of anesthesia*
General 373 (38) 336 (34.7)
Regional 518 (52.7) 536 (55.4)
General and regional 91 (9.3%) 95 (9.8)
Type of prosthesis*
Cemented 891 (90.7) 895 (92.6)
Noncemented 22 (2.2) 21 (2.2)
Hybrid 69 (7.0) 51 (5.3)
Duration of surgery† (min) 99.6 ± 36.1 97.3 ± 33.1
Time to first dose†‡ (h) 20.2 ± 3.5 20.2 ± 3.3
Tourniquet duration† (min) 77.8 ± 26.7 75.6 ± 25.7
Time to walking† (d) 1.9 ± 1.9 1.9 ± 1.6
Duration of hospital stay† (d) 5.6 ± 3.0 5.5 ± 2.7
*Values are given as the number of patients with the percentage in parentheses. †Values are given as the mean and the standard deviation. ‡Time to first morning dose of
ximelagatran or ximelagatran placebo.
TABLE E-II Evaluation of the Surgical Wound*
Characteristic Ximelagatran Warfarin
Wound bleeding
Unusual bruising and/or hematoma 63/1142 (5.5%) 51/1142 (4.5%) Intra-articular bleeding 13/322 (4.0%) 11/314 (3.5%) Wound appearance
Swelling 54/1142 (4.7%) 52/1141 (4.6%)
Drainage 48/1142 (4.2%) 29/1141 (2.5%)
Erythema 50/1142 (4.4%) 41/1141 (3.6%)
Bleeding 23/1142 (2.0%) 14/1141 (1.2%)
Treatment-emergent postoperative complications†
Wound site erythema 1/1151 (0.1%) 6/1148 (0.5%)
Wound seroma 4/1151 (0.3%) 0/1148 (0.0%)
Wound hematoma 3/1151 (0.3%) 5/1148 (0.4%)
Stitch abscess 3/1151 (0.3%) 4/1148 (0.3%)
Wound infection 31/1151 (2.7%) 26/1148 (2.3%)
Abscess 1/1151 (0.1%) 0/1148 (0.0%)
Wound dehiscence 3/1151 (0.3%) 5/1148 (0.4%)
Wound necrosis 1/1151 (0.1%) 2/1148 (0.2%)
*The values are given as the number of patients with each bleeding complication or those for whom the particular wound characteristic was “worse than expected” at any scheduled visit, including the follow-up visit. The denominators refer to the number of patients with data available. †According to terminology in an adverse event dictionary.